title: Recurrence of ovarian endometrioma after laparoscopic excision: risk factors and prevention.
abstract: OBJECTIVE
  The aim of this study was to assess the cut-off age of the risk factors for postoperative recurrence of ovarian endometriomas and to evaluate the end-points of follow-up after laparoscopic excision of ovarian endometriomas.
  
  
  METHODS
  We retrospectively reviewed 167 patients who underwent laparoscopic excision of ovarian endometriomas at our hospital between 2000 and 2009, and followed up the patients until 2010. Following surgery, patients chose to receive gonadotrophin-releasing hormone agonist, oral contraceptive pills (OCP), dienogest, or no medication and underwent regular ultrasonographic examinations. Potential risk factors for recurrence, including age at surgery, were assessed in the patients receiving no medication. Postoperative recurrence, defined as re-appearance of an ovarian endometrioma > 2 cm in size, was assessed for each treatment group.
  
  
  RESULTS
  Age at surgery was the only significant risk factor for recurrence, at a cut-off of 32 years, obtained through receiver-operator curve analysis. In patients not receiving medication, the recurrence rate gradually increased up to 50% over 5 years; there was no recurrence 5 years after surgery. Although no recurrence was seen in patients during continuous treatment with OCP or dienogest, the disease recurred in 55.5% of patients after discontinuing OCP.
  
  
  CONCLUSIONS
  Although adjuvant therapy for all patients may represent overtreatment, the findings of the present study suggest that, in the interest of fertility preservation, continuous postoperative hormonal treatment should be administered, at least to patients younger than 32 years. In patients who decline hormonal treatment, we recommend that they undergo follow-up for recurrence until 5 years after surgery.
authors.affiliation: Department of Obstetrics and Gynecology, Nippon Medical School, Tokyo, Japan.
authors.forename: Nozomi
authors.initials: N
authors.lastname: Ouchi
authors.forename: Shigeo
authors.initials: S
authors.lastname: Akira
authors.forename: Katsuya
authors.initials: K
authors.lastname: Mine
authors.forename: Masao
authors.initials: M
authors.lastname: Ichikawa
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Takeshita
mesh_terms: D000328:Adult; D004715:Endometriosis / Q000453:epidemiology / Q000517:prevention & control / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006785:Hospitals, University; D006801:Humans; D007564:Japan / Q000453:epidemiology; D010535:Laparoscopy; D010049:Ovarian Diseases / Q000453:epidemiology / Q000517:prevention & control / Q000601:surgery*; D010053:Ovary / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D016019:Survival Analysis
keywords: dienogest; endometriosis; oral contraceptives; recurrence; risk factor